Для корреспонденции: Прозоровский Дмитрий Вениаминович, кандидат медицинских наук, ГУ «Институт патологии позвоночника и суста-вов имени профессора М.И. Ситенко Национальной академии медицинских наук Украины», ул. Пушкинская, 80, г. Харьков, 61024, Украина; e-mail: prozorovskiy@mail

Treatment of static deformations of the forefoot with valgus deformation of the first toe remains relevant today. Objective. Toanalyze the results of surgery with severe hallux valgus using corrective proximal wedge-shaped osteotomy of the I metatarsalbone and corrective Lapidus arthrodesis. Methods. The results of surgical treatment of 104 women (147 feet) with severe halluxvalgus according to the Mann classification were evaluated. Age — 27‒65 years, follow-up period — from 10 months up to5 years. Performed: 65 (56.0 %) cases — corrective proximal wedge-shaped osteotomy of the first metatarsal bone with fixationwith LCP-plate or screws; 51 (44.0 %) — corrective arthrodesis of the first metatarsal-sphenoid joint with LCP-platefixation. All patients underwent Schede operation and lateral release of the 1st metatarsophalangeal joint capsule with tenoadductorotomy. The results of treatment were evaluated on the basis of X-ray data and the AOFAS scoring scale. Results.After osteotomy of the I metatarsal bone in 58 (89.2 %) patients, the treatment result was classified as good, in 7 (10.8 %) — satisfactory. The improvement of the average score was 42 points. After the application of Lapidus arthrodesis, the treatment result was good in 47 (92.2 %) cases, satisfactory in 4 (7.8 %), improvement of the average score was 40 points. Conclusions. Under the conditions of surgical treatment of hallux valgus, the proximal corrective wedge-shaped osteotomy of the first metatarsal bone should in some cases be combined with the distal corrective osteotomy of the first metatarsal bone due to the increase in the PASA angle. The Lapidus arthrodesis technique allows to minimize possible relapses of the deformity, in contrast to traditional corrective osteotomies of the first metatarsal bone due to the formation of ankylosis of the metatarsal sphenoid joint, but has longer consolidation periods and risks of non-union.

Postoperative rehabilitation of patients with hallux valgus is just as important, if not more so, than a technically flawless surgical intervention. Carrying out rehabilitation measures is an integral part of the postoperative period, which must be individual for each patient and depend on the volume and type of surgical intervention, the patient's age, and accompanying pathology. Objective. To improvethe results of the recovery of patients after orthopedic surgical interventions on the front part of the foot due to the developed complex system of postoperative rehabilitation. Methods. The articleprovides an analysis of the results of treatment of 70 patients with transversely spread deformation of the forefoot and hallux valgus 1–2 degrees using different approaches to rehabilitation measuresin the postoperative period. The patients were divided into 2 homogeneous groups by age, gender and degree of hallux valgus. Unlike the control group, manual therapy and myofascial massagetechniques were additionally used in the main group. The results. The results of the treatment were evaluated according to the AOFAS scoring scale for the forefoot, which is generally accepted inthe world. In the preoperative period, the average AOFAS score in the main and control groups was 65.4 and 64.7 points, respectively. 45 days after surgery, the average scores were 74.7 and 74.4 points,respectively. After 60 days, the average score in the main group was 92.1 points, and 82.6 in the control group. 3 months (90 days) after the surgical interventions, the average scores practically coincided in both groups and amounted to 93.7 points in the control group and 95.0 in the main group. The patients of the main group resumed their usual activities after 2 months. after the operation onthe front part of the foot, and the control after 3 months. Conclusions. The use of myofascial massage, manual therapy for mobilizing the metatarsophalangeal and interphalangeal joints of the toes with gymnastics to strengthen not only the stabilizers of the foot, but also to restore the bearing capacity of the girdle of the lower extremities and the stereotype of walking, made it possible to obtainnot only a positive functional result, but also to speed up the recovery compared to the control group per month.

Transverse-spread deformity of the forefoot with hallux valgus is found in 75 % of women in the population. At the same time, structural and functional changes in the foot lead to redistribution of load during walking between the heads of the metatarsal bones and the occurrence of metatarsalgia. Objective. To conduct a comparative analysis of the results of surgical treatment of metatarsalgia in patients with transverse-spread deformity of the forefoot after performing corrective osteotomies Helal and Weil. Methods. The study is based on the surgical treatment of 42 (64 feet) patients with metatarsalgia due to transverse deformity of the forefoot. Patients were divided into two groups depending on the surgical method of eliminating metatarsalgia: in the first performed an osteotomy Helal (32 cases), in the se cond -Weil (32). The mean followup of patients in the first group was 19.8 months, the second -21.5 months. Results. According to the assessment of AOFAS scale, the result of treatment of metatarsalgia and transverse deformity of the forefoot in patients of the first group was 89.4 points, the second -83.1 points. Regression of metatarsalgia in patients of the first group was recorded in 29 (90.6 %) cases, the second -in 26 (81.3 %) (criterion χ 2 = 1.16; p = 0.28). Recurrences of metatarsalgia were observed in patients after the use of both Helal and Weil osteotomies and accounted for 6.3 and 9.4 % of cases, respectively. The occurrence of transfer metatarsalgia of the anterior foot was registered in 3.1 % of cases after Helal osteotomy, in 9.4 % -Weil osteotomy. Conclusions. Surgical treatment of metatarsalgia caused by transverse deformity of the forefoot with the use of corrective osteotomies Helal and Weil allowed to achieve positive results in 90.6 and 81.3 % of cases, respectively. These surgical techniques can be successfully used for the treatment of metatarsalgia of the forefoot with a violation of the metatarsal parabola.